The spouse of a patient who experiences delusions asks the nurse, “Are there any circumstances under which the treatment team is justified in violating the patient’s right to confidentiality?” What is the nurse’s best response?
“We are not bound if the patient threatens the life of another person.”
“We can’t violate that confidence under any circumstances.”
“We are obligated to answer questions asked by law enforcement.”
“We can do that only at the discretion of the psychiatrist.”
The Correct Answer is A
Choice A reason: Confidentiality can be breached if a patient poses a threat to others, as in Tarasoff rulings, due to safety risks from delusions driven by dopamine dysregulation. This legal and ethical exception ensures protection, aligning with psychiatric principles prioritizing harm prevention over absolute confidentiality.
Choice B reason: Absolute confidentiality is incorrect, as exceptions exist for safety. Delusions, linked to mesolimbic dopamine excess, may lead to threats requiring disclosure. Legal frameworks allow breaching confidentiality to protect others, making this response scientifically and ethically inaccurate for psychiatric practice.
Choice C reason: Law enforcement inquiries do not automatically override confidentiality. Disclosure is limited to specific legal mandates, like imminent danger from dopamine-driven delusions. Routine questions do not justify breaches, making this response incorrect for the ethical and legal standards in psychiatric care.
Choice D reason: Confidentiality breaches are not solely at the psychiatrist’s discretion. Legal and ethical guidelines, like those for threats from delusional states, dictate exceptions. This option oversimplifies complex regulations, ignoring standardized protocols for managing risks in psychiatric patients, making it incorrect.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Discussing ego states is rooted in transactional analysis, not cognitive therapy. Ego states involve conscious and unconscious personality aspects, unrelated to addressing cognitive distortions like negative self-perception in inadequacy. Cognitive therapy targets thought patterns, not personality structures, making this approach scientifically irrelevant for the described intervention.
Choice B reason: Cognitive therapy focuses on identifying and modifying distorted thoughts, such as irrational beliefs about inadequacy, which are linked to altered serotonin and dopamine signaling in depression. By restructuring these thoughts, the therapy improves emotional regulation and behavior, aligning with evidence-based treatment for addressing feelings of inadequacy.
Choice C reason: Negative reinforcement is a behavioral therapy technique, not cognitive therapy. It involves removing aversive stimuli to increase desired behaviors, unrelated to addressing cognitive distortions like self-blame. Cognitive therapy targets thought patterns, not behavioral conditioning, making this approach scientifically inappropriate for the described therapeutic context.
Choice D reason: Focusing on unconscious processes is psychoanalytic, not cognitive, therapy. Inadequacy feelings stem from conscious cognitive distortions, not unconscious conflicts. Cognitive therapy corrects faulty thinking linked to neurotransmitter imbalances, not repressed memories, making this option misaligned with the scientific basis of the therapy described.
Correct Answer is D
Explanation
Choice A reason: Linking mental illness to brain disorders, like dopamine imbalances in schizophrenia, is factual and reduces stigma by emphasizing neurobiological causes. This aligns with scientific understanding, not perpetuating blame or stereotypes, making it an incorrect choice for reflecting stigma.
Choice B reason: Genetic predisposition, such as serotonin transporter gene variations, is a scientific explanation for mental illness. This reduces stigma by highlighting biological causes, not personal failings, aligning with evidence-based understanding and making it an incorrect choice for stigmatizing mental illness.
Choice C reason: Recognizing mental illness in children, like ADHD with dopamine deficits, normalizes early diagnosis and treatment. This factual statement reduces stigma by acknowledging neurobiological conditions across ages, making it an incorrect choice for reflecting stigmatizing attitudes toward mental illness.
Choice D reason: Blaming mental illness on family breakdown ignores neurobiological causes, like serotonin or dopamine imbalances, and perpetuates stigma by implying personal or social failure. This judgmental view misrepresents scientific evidence, making it the correct choice for reflecting stigmatizing attitudes toward mental illness.
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